Attitudes of nursing personnel toward death and dying: II. Linguistic indicators of denial.

This study was conducted to examine the attitudes of nursing personal toward death and dying by means of quantitative linguistic analysis. Previous research findings on the attitudinal concept of avoidance support the suitability of the approach. This study sought to examine the proposition that denial, another attitudinal concept appearing frequently in the literature on death and dying, would be manifested in language by increased use of negative lexical forms. It was hypothesized that the use of negatives would increase significantly in death-related responses as compared with non-death-related responses. The sample consisted of 40 nursing personnel interviewed on their expectations and care of terminally ill patients. Dependent variable measures include the ratio of negative lexical forms to total number of words for all death-related and all non-death-related responses. Similar proportions were obtained for selected response categories. Significantly more negatives were used in death-related responses, thus supporting the hypothesis. The value of these methods is discussed, as are the clinical implications for nursing.     

Trends in Child Poverty in Sweden: Parental and Child Reports

We use several family-based indicators of household poverty as well as child-reported economic resources and problems to unravel child poverty trends in Sweden. Our results show that absolute (bread-line) household income poverty, as well as economic deprivation, increased with the recession 1991–96, then reduced and has remained largely unchanged since 2006. Relative income poverty has however increased since the mid-1990s. When we measure child poverty by young people’s own reports, we find few trends between 2000 and 2011. The material conditions appear to have improved and relative poverty has changed very little if at all, contrasting the development of household relative poverty. This contradictory pattern may be a consequence of poor parents distributing relatively more of the household income to their children in times of economic duress, but future studies should scrutinze potentially delayed negative consequences as poor children are lagging behind their non-poor peers. Our methodological conclusion is that although parental and child reports are partly substitutable, they are also complementary, and the simultaneous reporting of different measures is crucial to get a full understanding of trends in child poverty.     

Comprehensive Meta-Analysis on Drug-Eluting Stents versus Bare-Metal Stents during Extended Follow-up

Background

Several observational reports have documented both increased and decreased cardiac mortality or Q-wave myocardial infarction with drug-eluting stents compared with bare-metal stents.

Methods

We sought to evaluate the safety and efficacy of drug-eluting stents compared with bare-metal stents early after intervention (<1 year) and late (>1 year) among a broad population of patients, using a meta-analysis of randomized clinical trials.

Results

We identified 28 trials with a total of 10,727 patients and a mean follow-up of 29.6 months. For early outcomes (<1 year), all-cause mortality for drug-eluting stents versus bare-metal stents was 2.1% versus 2.4% (risk ratio [RR] 0.91, [95% confidence interval (CI), 0.70-1.18]; P = .47), non-Q-wave myocardial infarction was 3.3% versus 4.4% (RR 0.78 [95% CI, 0.61-1.00]; P = .055), target lesion revascularization was 5.8% versus 18.4% (RR 0.28 [95% CI, 0.21-0.38]; P <.001), and stent thrombosis was 1.1% versus 1.3% (RR 0.87 [95% CI, 0.60-1.26]; P = .47). For late outcomes (>1 year), all-cause mortality for drug-eluting stents versus bare-metal stents was 5.9% versus 5.7% (RR 1.03 [95% CI, 0.83-1.28]; P = .79), target lesion revascularization was 4.0% versus 3.3% (RR 1.22 [95% CI, 0.92-1.60]; P = .16), non-Q-wave myocardial infarction was 1.6% versus 1.2% (RR 1.36 [95% CI, 0.74-2.53]; P = .32) and stent thrombosis was 0.7% versus 0.1% (RR 4.57 [95% CI, 1.54-13.57]; P = .006).

Conclusions

There was no excess mortality with drug-eluting stents. Within 1 year, drug-eluting stents appear to be safe and efficacious with possibly decreased non-Q-wave myocardial infarction compared with bare-metal stents. After 1 year, drug-eluting stents still have similar mortality, despite increased stent thrombosis. The reduction in target lesion revascularization with drug-eluting stents mainly happens within 1 year, but is sustained thereafter.     

Symmetrical peripheral digital gangrene following severe Plasmodium falciparum malaria‐induced disseminated intravascular coagulopathy

Ghafoor SZA, MacRae EA, Harding KG, Patel GK. Symmetrical peripheral digital gangrene following severe Plasmodium falciparum malaria‐induced disseminated intravascular coagulopathy. Symmetrical peripheral digital gangrene is a life‐changing complication, caused by a pro‐thrombotic life‐threatening disease, such as disseminated intravascular coagulopathy (DIC) secondary to systemic infection. We describe the unusual case of a woman who developed symmetrical peripheral digital gangrene following DIC because of malaria. While initial treatment led to cure of the infection, in this report we describe also the subsequent management of symmetrical peripheral digital gangrene.     

Treatment of refractory adult lymphoblastic leukemia (ALL) with 4'(9- acridinylamino) methanesulfon-M-anisidide (AMSA)

Twenty-four adults with ALL were treated with AMSA alone or in combination. Twenty-two were treated at time of relapse and two patients after failing primary induction therapy. All had been treated with anthracyclines prior to receiving AMSA. Of the 22 patients with ALL in relapse, 4 achieved a complete remission. Two of these patients have relapsed while receiving maintenance chemotherapy; one died 1 mo after achieving remission due to the occurrence of cholycystitis in the setting of pancytopenia and one patient underwent bone marrow transplantation and is in remission at 8 mo after the second remission. Both patients who failed primary induction therapy remain in remission at 11 and 36 mo, respectively. The use of AMSA should be considered for patients with ALL who fail primary induction as well as those whose leukemia becomes resistant to conventional agents.